KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAD, THIRUVANANTHAPURAM
APPEAL 184/2010
JUDGMENT DATED: 27..4..2011
PRESENT
SMT.VALSALA SARANGADHARAN : MEMBER
SRI.M.V.VISWANATHAN : JUDICIAL MEMBER
SRI.M.K.ABDULLA SONA : MEMBER
1. Senior Divisional Manager, : APPELLANTS
Divisional Office, LIC of India,
Calicut.
2. Senior Branch Manager,
LIC of India, Branch Officer – II,
Fort Road, Kannur.
(By Adv.G.S.Kalkura)
Vs.
1. Rohini.K., : RESPONDENTS
D/o Kunhappa, Rajitha Bhavan,
Kodukkimotta.P.O., Kanhirode, Kannur.
2. Sindhu, D/o Gopalan,
-do-do-
3. Nithika(M) aged about 14 years,
D/o Sasidharan, rep.by next friend
Mother Sindhu,
-do-do-
JUDGMENT
SRI.M.V.VISWANATHAN : JUDICIAL MEMBER
The appellants are the opposite parties and respondents are the complainants in CC No.209/06 on the file of CDRF, Kannur. The complaint therein was filed alleging deficiency in service on the part of the opposite parties in repudiating the insurance claim preferred by the complainants with respect to the policy No.794267072 which was issued in the name of Sasidharan, son of the 1st complainant and husband of the 2nd complainant. The 3rd complainant is the daughter of the life assured Sasidharan. The opposite parties entered appearance and filed written version denying the alleged deficiency in service. They contended that the subject life policy became lapsed due to non payment of the premium which was due in the month of April 2006 and that the life assured failed to remit the said premium within the grace period of one month. Thus, on 15..5..06 the subject policy became lapsed. Thereby, the opposite parties justified their action in repudiating the insurance claim.
2. Before the Forum below the 1st complainant was examined as PW1 and a witness from the side of the opposite parties was examined DW1. Exts.A1 to A4 and B1 to B3 documents were also marked on the side of the parties to the said complaint. On an appreciation of the evidence on record, the Forum below passed the impugned order dated 17th February 2010 directing the opposite parties to settled the insurance claim by paying the assured sum after deducting the premium due to the opposite party LIC of India. The complainants were also allowed cost of Rs.1000/-. Hence the present appeal.
3. We heard both sides. The learned counsel for the appellants/opposite parties submitted his arguments based on the grounds urged in the memorandum of the present appeal. He argued for the position that the complainants failed in establishing their case that the life assured Sasidharan was in a coma stage from the date of his treatment till his death on18..5..06. It is further submitted that the subject life policy issued in the name of the policy holder Sasidharan was in a lapsed condition on the date of death of the life assured and thereby the appellants justified their action in repudiating the insurance claim. On the other hand, the learned counsel for the respondents/complainants supported the impugned order passed by the Forum below. He relied on the documentary evidence on record argued for the position that the life assured Sasidharan was in a coma stage from 27.2.06 till his death on 18.5.06 and that the life assured had no opportunity to remit the quarterly insurance premium which fell in due on 15..4..06. It is further submitted that the life assured had the grace time upto 15.5.06 and that the life assured died on 18.5.06 while undergoing treatment at Pariyaram Medical College Hospital, Kannur. Thus, the respondents prayed for dismissal of the present appeal.
4. There is no dispute that the 2nd complainant’s husband C.Sasidharan was the policy holder of the life policy with policy No.794267072. The said policy commenced on 15..10..04. The sum assured was Rs.3,00,000/- and the mode of payment was quarterly. The 2nd complainant Sindu is the nominee of the life assured Sasidharan. Ext.B1 is copy of the aforesaid life policy issued by LIC of India in the name of life assured Sasidharan. Admittedly, the quarterly premium for April 2006 became due on 15..4.06. The life assured had remitted the quarterly premiums and the said policy was in existence till 15..5..06. There is no dispute that there was a grace period of one month for remitting quarterly premium. Thus, the quarterly premium which was due on15.4.06 had the grace period upto 15.5.06.
5. The definite case of the complainants is that the life assured Sasidharan became unconscious on 25.5.06 after omitting blood and the life assured Sasidharan was admitted in Dhanalaskshmi Hospital, Kannur and thereafter on 26.2.06 he was taken to MIMS hospital, Kozhikode for better treatment and thereafter on 30.3.06 he was admitted in Medical College Hospital, Pariyaram, Kannur. The life assured continued his treatment at that hospital till his death on18..5..06. It is specifically averred that the life assured died due to cardiac arrest on18..5..06 while undergoing treatment in Medical College Hospital, Pariyaram, Kannur and that the life assured was in a coma stage till his death on 18..5..06. It is the further case of the complainants that the complainants were not aware of the existence of the subject life policy and they could not remit the premium within the grace period. And that the life assured was not in a position to remit the premium for the said policy because of the fact that he was in coma stage.
6. Ext.A1 is the death certificate issued by the doctor attached to Pariyaram Medical college Hospital, Kannur. The genuineness and correctness of A1 death certificate is not in dispute. A1 death certificate would make it abundantly clear that the life assured Sasidharan was admitted in that hospital on 30.3.06 at 8.50PM and that he was in a coma stage. It is specifically stated in A1 certificate that the life assured Sasidharan was admitted in that hospital with cirrhosis liver (ALD) portal hypertension, Hepatic encephalopathy – coma. It is also stated in A1 death certificate that the patient Sasidharan died on 18..5..06 at 1.55PM and the cause of death is shown as cardiac arrest. Ext.A1 certificate is dated 18.5.06. Thus, A1 death certificate would establish the case of the complainants that the life assured Sasidharan was in a coma stage when he was admitted in Pariyaram Medical College Hospital on 30.3.06 and he continued his treatment in that hospital till his death on 18.5.06.
7. The case of the appellants/opposite parties that the complainants could not establish their case that the life assured Sasidharan was in a coma stage till his death on 18..5..06 cannot be accepted. On the other hand, A1 death certificate would establish the fact that the life assured Sasidharan was admitted in Pariyaram Medical College on 30..03..06 in coma stage and he died on 18..5..06 while undergoing treatment in that hospital for cirrhosis liver, portal hypertension, hepatic encephalopathy. The Forum below is perfectly justified in entering on a finding “that the deceased was under coma”. No other document is forthcoming from the side of the opposite parties to disprove the entries in A1 death certificate. It is further to be noted that A1 death certificate has not been disputed by the opposite parties.
8. Admittedly the subject policy was in existence and the same was effective on 30.3.06 the date of which life assured Sasidharan was admitted in the hospital under coma stage. Quarterly premium for the said policy was due on 15.4.06. The said policy had the grace time of one month. It can be seen that the said policy was effective upto 15..5..06. The life assured Sasidharan died on 18..5..06 ie, the death of the life assured occurred after three days of the stipulated time for making payment of the quarterly premium. It can very safely be concluded that the life assured Sasidharan was not in a position to remit the quarterly premium for the subject policy because of the fact that he was in coma stage from 30.3.06. It is not just, proper or fair on the part of the opposite parties(LIC of India) in repudiating the insurance claim with respect to the subject policy on the ground that the quarterly premium which was due on 15.4.2006 could not be remitted by the policy holder. It is pertinent to note that the policy holder was very prompt in remitting the quarterly premium for the subject policy. Unfortunately, the policy holder could not remit the quarterly premium which became due on 15.4.06 only because of the fact that the life assured was admitted in the hospital in coma stage and he continued in that stage till his death on 18..5..06. So, this is a fit case for the LIC of India to honour the insurance claim with respect to the subject policy. The Forum below has rightly directed the opposite parties to honour the insurance claim by paying the sum assured after deducting the defaulted quarterly premium.
9. The complainants have got a definite case that they were not aware of the subject life policy No.794267072 which was taken by the life assured Sasidharan. The 1st complainant as PW1 has also deposed to that effect. There is no reason to disbelieve the testimony of PW1 regarding the inability of the complainants to remit the insurance quarterly premium for the subject policy. Thus, the insurance claim preferred by the complainants ought to have been honoured by the opposite parties. The Forum below has rightly directed the opposite parties to honour the insurance claim by paying the assured sum after deducting the defaulted premium. The Forum below can also be justified in awarding cost of Rs.1000/-. Thus, in all respects the impugned order passed by the Forum below is liable to be upheld. Hence we do so.
In the result the appeal is dismissed. The impugned order dated 17..2..2010 passed by CDRF, Kannur in CC.209/06 is confirmed. As far as the present appeal is concerned, the parties are directed to suffer their respective costs.
M.V.VISWANATHAN : JUDICIAL MEMBER
VALSALA SARANGADHARAN : MEMBER
M.K.ABDULLA SONA : MEMBER
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